Gerene Denning, of the University of Iowa Department of Emergency Services, presented this at CPSC's ATV Safety Summit Oct. 12, 2012. High Proportions of Roadway Deaths and Injuries on ATVs Suggest Poor Knowledge and Compliance with Road Use Laws. Objectives: To compare fatal and non-fatal ATV crashes on and off the road. Methods: Retrospective studies were performed using national fatality data (CPSC) and statewide injury data. Results: From 1985-2009, 62% of U.S. ATV deaths resulted from roadway crashes, and roadway deaths since 1998 have increased at a greater rate than off-road deaths. Fatal roadway crashes were more likely than off-road crashes to result in multiple deaths and to involve multiple riders, higher alcohol use, more collisions, and more head injuries. Similarly, non-fatal Iowa roadway crashes (2002-2009) involved more passengers, alcohol use, and collisions as compared to off-road crashes. Helmet use was significantly lower in roadway crashes relative to off-road; and more severe injuries overall, including head injuries, characterized roadway crashes. Both studies showed helmets reduced the likelihood of head injury. Conclusion: Despite road use laws, over half of U.S. ATV-related deaths and one-third of serious injuries in Iowa resulted from roadway crashes. We hypothesize that multiple risk factors exacerbate the inherent difficulty of safely operating ATVs on roads, and that speed and lack of protective equipment increase injury severity. Improving knowledge and enforcement of road use laws may be an effective way to reduce ATV-related deaths and injuries.